Nodal illness is a significant predictor of prognosis and treatment in head and neck cancer. The frequency of concealed nodal metastases is rather high despite the use of contemporary multimodality diagnostic imaging. The lymphatics are therefore “electively” treated in clinically node-negative head and neck cancer in order to remove any subclinical tumor deposits. As a result, numerous true node negative patients receive unneeded neck surgery or irradiation and experience early and long-term morbidity. A more precise evaluation of nodal status before to therapy is necessary to safely customize head and neck cancer treatment to each patient. In this review, we examine the possibility of a number of novel diagnostic techniques to direct tailored treatment of the clinically negative neck in head and neck cancer patients.
890,000 new cases and 450,000 deaths due to head and neck squamous cell carcinoma (HNSCC) were reported globally in 2018, and the 5-year survival rate is 50–60% overall. About one-third of all patients have a clinically positive neck at the time of diagnosis. Nodal involvement is a crucial prognostic factor and therapy factor since it is linked to a higher risk of local recurrences and distant metastases.
Neck dissection, (chemo) radiotherapy, or a combination of these treatments are used to treat lymph node-positive necks. The initial tumor’s location, stage, and size, as well as the patient’s age, performance status, and preferences, all influence the course and mode of treatment. The neck is often treated using the same technique as the original tumor. There has been much discussion over how to handle the clinically negative (cN0) neck, which is defined as having no nodal metastases after a state-of-the-art diagnostic work-up. A decision analysis approach was developed decades ago to identify the best treatment plan for cN0 patients. If there was a 20% or greater chance that the illness was subclinical nodal metastatic, neck surgery was deemed necessary.
If there was a 20% or greater chance that the illness was subclinical nodal metastatic, neck surgery was deemed necessary. In 80% of cN0 patients, this results in overtreatment by definition. Since then, more recent decision models have been used, and results have varied. Modern perspectives on the management of the cN0 neck, however, place more significance on individual, institutional, and other relevant aspects to maximize management of the neck and place less emphasis on cut-off values.
A substantial morbidity profile, including reduced shoulder function, post-operative discomfort, and nerve injury, is linked to surgical neck procedures. Following neck irradiation, there is a dose-dependent risk of xerostomia, dysphagia, carotid artery atherosclerosis, and hypothyroidism. The most significant negative predictors of quality of life are xerostomia and dysphagia, and atherosclerosis of the carotids increases the risk of ischemic brain infarctions and reduces life expectancy. Therefore, a primary goal of clinical research should be to safely reduce the intensity of therapy in order to prevent these consequences. To do this, a more precise pre-treatment evaluation of neck condition is needed.